Healthcare Provider Details

I. General information

NPI: 1992387237
Provider Name (Legal Business Name): MADISON ANNE STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 CLEVIDENCE BLVD STE C
CLARKSVILLE IN
47129-2278
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 812-280-6623
  • Fax: 812-280-6632
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01099596A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number62221
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: